The "Childmyths" blog is a spin-off of Jean Mercer's book "Thinking Critically About Child Development: Examining Myths & Misunderstandings"(Sage, 2015; third edition). The blog focuses on parsing mistaken beliefs that can influence people's decisions about childrearing-- for example, beliefs about day care, about punishment, about child psychotherapies, and about adoption.
See also http://thestudyofnonsense.blogspot.com

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Concerned About Unconventional Mental Health Interventions?

Wednesday, August 19, 2015

It was only a few weeks ago that I first encountered
the name of the California psychologist Craig Childress. The context was a
discussion with advocates of the concept of parental alienation (PA to its
familiars). If you have not yet encountered PA, you have been lucky so far, but
that luck is about to run out if you keep reading. There may be such a thing as
PA—no doubt there sometimes is—but it is embedded in a morass.

PA is a designation for the events and results that
may occur in a divorce if one parent influences a child to reject the other. The
rejection is evidenced by the child’s willingness to remain in the care of one
parent but fear of and reluctance to be with the other. If the first of these
people is seen to be persuading the child to fear and avoid the other parent,
the former is sometimes described as the alienating parent, and the latter as
the alienated parent (although this last is rather confusing because it is the
child who feels alienated from the rejected parent, not the parent himself or
herself). My own preference would be to call the people the accepted parent and
the rejected parent, respectively.

Some students
of PA, especially, it seems, those connected with fathers’ rights groups,
propose that a child cannot develop in a mentally healthy fashion without
relationships with both parents, and that therefore the alienation must be
resolved for the child’s own sake. As a result of this assumption, they define
situations of PA as child abuse, unless there are rational motives for the
child’s rejection, for example that the rejected parent has been frightening or
abusive in the past. If PA is abusive, the accepted parent is an abuser, and
needs to have his or her behavior corrected; the rejected parent is a victim,
and needs the relationship with the child restored in order to facilitate the
child’s emotional development. When courts are in the picture, of course, the
treatment of the accepted and rejected parents can include the threat or
reality of custody or visitation changes as means to stop PA, or court-ordered
therapies designed to correct the situation and foster good relations between
the child and the parent(s) who cooperate in the process.

Advocates of PA have argued that there is a
definable parental alienation syndrome (PAS) that should have been included in
DSM-5. The DSM-5 group rejected this proposal on the grounds that there is no
evidence that PAS exists in some way that makes it separate from other
diagnoses in the manual. Similarly, there is at this time no support for the
idea that any treatment used for PA is an evidence-based treatment. (This is
why I refer to all this stuff as the parental alienation swamp.)

Now, here’s where we get to Craig Childress.
Childress, a licensed clinical psychologist in California with a Psy.D. degree,
and a faculty member at California Southern University, a distance-learning, on
line outfit, has attacked others’ claims to treat PA and has presented his own
claim that he knows 1) what causes PA behavior by accepted parents, and 2) how
to treat the child’s rejection of one parent. He has published a book with a “boutique”
publisher, Oaksong Press, about how this all works, and maintains an elaborate
Facebook page and web site to argue for his views. There he comments on the “abject ignorance” of
his opponents, a statement no doubt entertaining to some of the FB audience,
but certainly not professional discourse. (Childress’ on line CV appears to
show no activity between 1985 and 1998, raising more than one question about
his professional history.)

Let’s have a look at Childress’ claims about the
sources of PA behavior by the accepted parent and the impact it has on a child.
Childress attributes a parent’s persuasion of a child to reject the other
parent to re-enactment of the accepted parent’s own traumatic attachment
history. Where such a history exists, he
proposes, the affected parent develops a narcissistic/borderline personality,
with a tendency to “split” the world into all-good and all-bad components.
Childress chooses two aspects of a problematic development of attachment as
critical here: the early existence of disorganized attachment, and
relationships that involve role reversals, so that, e.g., child cares for
mother. These characteristics, according to Childress, make the accepted parent
a “pathogenic parent”. This is an
interesting set of ideas, and eminently testable by empirical means. But…
Childress has not done this testing, and although on his web site he refers to his
claims as “well established in the scientific literature” (notably omitting a
list of references), this is certainly not the case if we assume as many do
that “scientific literature” involves empirical work beyond the level of
anecdote or clinical report. Yes, attachment theory is based on careful
observational work and on longitudinal studies, but the fact that there is a
scientific foundation for some aspects of attachment does not mean that the
foundation can properly be generalized to every statement that shares concepts
with attachment theory. (There is a good deal of this kind of thing around just
now, I’m afraid.) As for pathogenicity of any parenting pattern, this requires
longitudinal study to ascertain.

Let’s look at Childress’ claims about treatment of
PA effects on children. He rejects the idea that reunification can be facilitated
by work with the child and both parents. Instead, he proposes that help can be
given only by “protective separation” of the child from the accepted parent.
During this period of separation, the child experiences treatment as described
by Childress on his web site, with the goal of coming to enjoy and seek to be
with the formerly rejected parent. If the child is successful in meeting this
goal for 10 weeks, two one-hour Skype or phone sessions per week with the
formerly-accepted parent will be allowed. According to Childress, this method
empowers the child: “It is in the child’s power to extend or shorten the
Treatment period. If the child continues to remain symptomatic [i.e., express
rejection of the parent], then the Treatment period can be continued to six
months or longer. However, if the child chooses [sic, N.B.] to become non-symptomatic, then the Treatment period can
be ended in as little as 8 weeks or less, based on the child’s behavior. “
Childress argues that a study design can be used to demonstrate the
effectiveness of this method, but he does not appear to have done this, nor
does he take into account the effect of maturational change.

Is Childress’ approach less supported by empirical
work than other PA approaches? No, it is not, although his pugnacity and undue
confidence about his statements tend to obscure that fact. Actually, all of the
PA discussions of which I am aware, as well as many judicial decisions
concerned with parenting relationships, have the same flaw. They completely
neglect to consider the effects of developmental
change on the child’s interactions with the social environment and their effect
on him or her. The effects of parenting patterns on children involve transactional processes in which each
person affects the other in ways that change over time; the changes occur
because of learning by both parties and because of maturational changes, rapid
in the child and slow but present in the adult. This means that when treatment
is appropriate (an enormous issue), the way it is done, especially if it is to
involve separation from the accepted parent, must be congruent with the child’s
developmental needs for attachment and for exploration. These are vastly
different in toddlers and in kindergarteners, and different from both in
teenagers. Perhaps Childress does not mean to suggest that a two-year-old who
resists going with his father should be separated from the mother for 8 or 10
weeks or longer-- but if he does not
mean this, he would do well to say so.

There are many more issues to be considered here. I
am still taken aback, I must say, by Childress’ view that a child may “choose”
whether or not to show fear and rejection of a parent; there is a flavor of “breaking
the spirit” about the whole thing. But the main considerations, I think, are 1)
show us the evidence for these claims, 2) tell how developmental age should be taken
into account, and 3) describe the treatment goals in transactional terms. This
is a challenge that I hope will eventually be addressed not only by Childress
but by other PA proponents.

Sunday, August 16, 2015

People who are interested in psychology as a subject
of study or as a profession can hardly have missed the recent brouhaha in the
American Psychological Association, following public attention to the
complicity of psychologists and the organization itself with the use of torture
in the interrogation of prisoners at Guantanamo. This complicity of the
organization included some shuffling of the ethical code to make it acceptable
for psychologists to recommend “enhanced” interrogation techniques and thus to
make themselves agreeable to the Department of Defense. (The American
Psychiatric Association refused to do this, and they are most pleased with
themselves-- which I acknowledge that
they have every right to be.)

At the recent
APA (that’s the psychologists) annual convention in Toronto, “town hall” meetings discussed the
ethical issues concerned, and a resolution was passed, with only one dissenting
vote. Among other things, the resolution stated that APA members should not be
involved in national-security-related interrogations in any way, including
supervising or advising on how other people do them. Members of APA were
invited by e-mail to give feedback on this resolution, and I did so. Here is what
I said:

“In my
opinion, the resolution, with its focus on national security issues, completely
misses the point. Psychologists should not employ or contribute
to methods that are potentially harmful, whether the context is national
security, domestic prisons, residential treatment centers, or outpatient
treatment. In addition, there should be a clearly-stated ethical obligation for
psychologists who become aware of such actions by other psychologists
to call attention to them by reporting to APA or to licensing authorities. APA,
in turn, needs to be responsive to such reports and to make public statements
about substantiated reports even when the offending psychologist is not an APA
member.”

Psychologists
as a group have never adopted the principle of primum non nocere (first, do no harm). There has been a
long-standing assumption that what psychologists do must be beneficial—why would
we call it “therapy” if it isn’t good for you? Nocere has not been considered to be one of the options; in fact,
when patients found treatments distressing, it was assumed that such distress
was needed to motivate change or to overcome resistance, and that in the long
term such unpleasant experiences were actually beneficial. This attitude was
especially prevalent in the ‘70s, when bullying at Esalen was considered a
viable intervention, when two practitioners in Flagstaff, AZ caused the death
of an adult patient through physical methods, when Robert Zaslow lost his
California psychology license after serious injuries to a patient, and John
Rosen in Philadelphia apparently pushed a patient down a flight of stairs.
Today, painful “psychotherapy” for adults is less common, but distressing
methods for children, especially adoptees, are still advocated by some
practitioners. These people may argue that just as chemotherapy for childhood
cancer is painful but necessary, the treatments they use are similarly
distressing but needed; unfortunately for their argument, they forget that
there is good evidence for the efficacy of chemotherapy, but no such evidence
for distressing psychological interventions.

In recent
years, a small groundswell of disapproval for harmful behavior by psychologists
has begun to appear. I can point to my own efforts to fight holding therapy by
describing its distressing and physically harmful effects, beginning in 2001. Scott
Lilienfeld in 2007 suggested the term “potentially harmful treatments” (PHTs) for
interventions that have a history of doing harm or that could reasonably be expected
to cause harm. The PHT designation provided a category whose existence
indicated that nocere was in fact one
of the options for psychologists—not all “therapies” were actually therapeutic.
More recently, Michael Linden, a German psychiatrist, has put forward the
concept of adverse events of various types that can accompany psychological
interventions, just as they may occur with physical or pharmaceutical treatment.
In a 2013 paper, Linden argued that feeling distress during psychological
treatment should be considered an “emotional burden” and an unwanted side
effect that should be avoided if at all possible.

These facts
about psychological treatment and its potential for harm, in my opinion, need
to be added to APA’s discussion of the harm done by psychologists who
supervised torture. Simply to refrain from engagement with the Department of
Defense provides only a small part of the solution to the problem. It is time
for psychologists-- and not only
psychologists, but other mental health workers—to recognize that there is a
power for ill as well as good effects in our practices. It is time for us to
stop passing by “on the other side”, like the priest and the Levite, when harm
is caused to any person by the exercise of psychological skills. When APA
recognizes this and builds awareness into the code of professional ethics, we
may be able to move forward. As long as we point the finger only at the guilty
parties at Guantanamo, we cannot.

A recent e-mail from Jessica Pegis called my
attention to a set of “rules for bonding” as put out by the magazine Adoption Today (www.adoptiontoday.com/bondingarticle2.html).
An on line article on this topic, “Jump-starting attachment with babies and
toddlers”, by Mary Ostyn, contains a range of misunderstandings about
attachment and young children’s needs, as well as some good advice – e.g., that
nurturing does not “spoil” a child.

My first concern about Ostyn’s remarks is that they
suggest that attachment (not bonding) is something an adult can do TO a child,
and that it is accomplished by ritually re-enacting with toddlers the behaviors
that are normal parts of caring for infants. The term attachment refers primarily to attitudes and behaviors of young
children toward adults, although some authors have tried to bring all later
relationships under the attachment umbrella. As far as we presently know,
attachment of a child to a caregiver occurs when the caregiver is sensitive and
responsive to the messages the child sends about needs and wishes—that is, when
the caregiver pays close attention to the child’s communications about both
affectionate interactions and autonomy. (This kind of attention and response is
just one detail of what is sometimes called “following the child’s lead”).

Ostyn seems to assume that the caregiving behaviors
that typically precede an infant’s attachment to a parent are identical with
the behaviors that will encourage attachment in a toddler or preschooler. My
guess is that she takes this position because she shares with advocates of
attachment therapy the belief that a child who has experienced separation has
in some way been blocked from and stopped further development, and therefore
experiences characteristic of early life must be recapitulated in order to “jump-start”
typical development. However, the fact is that no living child stops developing
in any way. Development may be distorted by events, but it continues to occur.
This means that a toddler who has undergone separation cannot be considered to
be stuck at the stage of development where she was at the time of separation.
It’s more accurate by far to consider that aspects of development have been
derailed and need to be guided back onto a desirable track.

Re-enacting baby care with an older child is thus
not a plausible approach to helping kids who have experienced rough histories.
What’s more, this kind of re-enactment of events ignores the important role
played in attachment by the caregiver’s responsiveness to the child’s signals.
Just doing what a caregiver thinks ought to be done may well involve being unresponsive
to child communications, especially if a child is hard to “read”.

As Mary Dozier has pointed out, improving the parent’s
ability to understand subtle child cues is the way to improve the child’s
attachment to that parent; caregivers who proceed to follow “rules” without considering
the child’s signals are working against attachment, not toward it. Ostyn
suggests actually ignoring child cues to insist upon physical contact. She also
ignores the fact of the typical extreme ambivalence of the toddler toward being
held and being let go – the behavior that Margaret Mahler called a “rapprochement
crisis”, where a normally-developing child wants to be held and then put down,
wants help and then has a tantrum when receiving it, etc. Rather than recognizing age-appropriate
behavior, Ostyn is confused by her assumptions about “stuck” development into thinking that this is
an expression of genuine reluctance to develop a relationship. Instead, it’s an
opportunity for a caregiver to show responsiveness to the confused and
confusing signals the child is giving. The child’s desire for autonomy needs to
be honored as much as the child’s desire for attachment—and I am at a loss as
to how hours of carrying a big child can accomplish this, especially when the
child resists. Once again, following the child’s lead as much as is practical
is the way to go; carrying out a ritual re-enactment of some idea of infant
care is not.

This leads me to the whole feeding issue. According
to Ostyn, “bottlefeeding is great for bonding”—but there’s certainly no
evidence that it makes any difference to attachment, any more than
breastfeeding does. Does she mean that bottlefeeding makes a caregiver feel
good? That would make sense if she’s really talking about bonding, which is the
increased positive feeling of the adult for the child. Not so much if she means
attachment, the feeling and behavior of the child toward the adult, however. A
toddler or preschool child is likely to resist being given a bottle and will
probably want to hold it herself and even take the nipple off to drink better,
but caregivers who are convinced by Ostyn will not follow this lead as they
should. (Some will even interpret these actions as a refusal to attach to them
and a personal dislike.)

As a further
comment on feeding, Ostyn advises that only the mother should feed the child,
and all treats should come from the mother. Here we have a clear commitment to
the Freudian concept of attachment as “cupboard love” created by associating a
caregiver with food or other gratification. This outmoded view has long ago
been replaced by the idea of attachment as a robust development that occurs in response
to pleasurable social interactions and adult sensitivity to child
communications. Certainly mealtime offers many opportunities for happy social
engagement and responsiveness to the child’s cues, but these are not based on
satisfaction of hunger or experience of “treats”. I might point out also that
the idea of monotropy, the attachment of the child to a single individual, as initially
argued by John Bowlby in an analogy to the imprinting of ducklings, is long
gone from professional discussions of attachment. Most children experience
attachment to several caregivers, including fathers and grandparents, and
benefit from learning that there are a variety of ways of having pleasurable
social play.

Ostyn should be given credit for a couple of good
suggestions. One is about responsiveness to children’s night-time concerns, and
in her comments about this she does encourage sensitivity and responsiveness to
child communications. Her comments about playing on the floor every day are
also excellent. “Floortime” (as it was dubbed by Stanley Greenspan) offers many
opportunities for pleasurable, sensitive, and responsive communication and for
following the child’s lead in play.

You can’t “jump-start” attachment by making the
child go through ritual re-enactments of infancy. But you can gradually
encourage a child’s attachment by becoming sensitive to subtle communications
and being willing to follow the leads he gives you. If this seems difficult, sometimes
it can be helpful to make videos of your interactions with the child and to
look at them later to see whether there are cues that you are missing and leads
you are not following. Keep in mind, too, that a toddler is developing
attachment relationships that include negotiation and compromise, not just
dependence, and that autonomy is an essential goal for development. That
toddler or preschooler is not literally “stuck” at a baby’s emotional level—he or
she needs experiences that resonate with current needs, not to what some adults
imagine as past needs.

About Me https://en.wikipedia.org/wiki/Jean_Mercer

Jean Mercer has a Ph.D in Psychology from Brandeis University, earned when that institution was 20 years old (you do the math). She is Professor Emerita of Psychology at Richard Stockton College, where for many years she taught developmental psychology, research methods, perception, and history of psychology. Since about 2000 her focus has been on potentially dangerous child psychotherapies, and she has published several related books and a number of articles in professional journals.
Her CV can be seen at http://childmyths.blogspot.com/2009/12/curriculum-vitae-jean.mercer-richard.html.